Three Takes on Healthcare Delivery

TAKE 1 Getting Mobile: Andrea Parker motivates people through gaming

As an innovator in personal health informatics, Andrea Parker is devising ways to use technology to help those in poor neighborhoods make better choices about their health.

As any teenager can tell you, technology is (a) fun and (b) one of the best ways to create a sense of community. So by creating health-related games and discussions, Parker has been able to engage her audience, create a community that supports healthy decisions, and provide the knowledge people need to make the right choices.

Parker is collaborating with her Northeastern colleagues to create mobile applications, games, and social media to convince low-income families to exercise more and eat more nutritiously. To be effective, she says the technology has to “feel authentic and connect naturally with their lives.”

She has already achieved success in Atlanta, where she designed a mobile game called OrderUp! in which low-income people assume the role of waitstaff in a neighborhood restaurant. The challenge was for participants to serve virtual customers as quickly and healthfully as possible. Parker’s research showed that the game shifted user perception of what constitutes a healthy meal.

“Users started to reassess their own behaviors and began to see how they could make and eat healthier foods themselves,” she says.

Parker also designed an application that encourages participants to share text messages documenting their eating habits. The messages were displayed on a large touch-screen display installed at the local YMCA. At the end of a three-month study, Parker found that participants had come to think of themselves as community health advocates.

“These kinds of technologies are not just helping people change their own habits, but they are also developing participants’ identities as advocates for change,” she says. “It’s exciting to think about the influence these people could have on their social networks.”

TAKE 2 Data Driven: Gary Young shapes healthcare policy

Just as the Affordable Care Act (better known as “Obamacare”) takes effect, Gary Young’s landmark study on hospital spending has fueled a national debate over the amount of money U.S. hospitals devote to community healthcare.

The study, published in April in the New England Journal of Medicine, reveals wide disparities in the free services hospitals offer for preventive care and community health.

Young and his interdisciplinary team found that some hospitals devote more than 20 percent of their operating budget to community benefits, while others contribute less than 1 percent.

Young was also surprised to find there is no correlation between need and the community services offered by the local hospital. Young’s team had hypothesized that the spending disparity would reflect the amount of poverty in a community—that hospitals in wealthy communities spent little because there was less need, and hospitals in communities that have high poverty rates spent more. But his analysis of the data showed no correlation whatsoever.

Furthermore, even among hospitals with the highest spending levels, these benefits are unlikely to include preventive medicine and wellness education, the study shows.

The implications of Young’s research are profound. It raises questions about whether hospitals are, at least in part, charitable institutions that deserve tax-exempt status, or large corporations that get richer from tax breaks they don’t deserve.

“Some believe that there should be a closer examination of the appropriateness of tax exemption for these organizations, which are often billion-dollar enterprises,” says Young.

In fact, Young will help answer that question himself. The IRS recently appointed him to a two-year term on a committee charged with rewriting the rules governing how corporations qualify for tax-exempt status.

Meet Tanya, an avatar—or “relational agent” as Tim Bickmore calls her—who functions as both a nurse and personal health advocate. If you want to know how to change your dressing after surgery, Tanya can show you. If you’re a senior citizen who’s nervous about all the medications you have to take each day, Tanya understands and can help put you at ease.

Bickmore is working on ways to use technology to help patients manage their healthcare more effectively. By studying the behavior of real doctors and nurses, and then turning his observations into complex computational algorithms, he’s able to create avatars that show empathy and converse naturally with patients.

“We’re always going back to source videos to capture the essence of the expert,” he explains. “We look a lot at non­verbal behaviors, like hand gestures, gaze cues, and head nods.”

His avatars can “remember” past interactions and build an ongoing relationship with the patient. And unlike busy healthcare professionals, avatars have unlimited time to walk patients through confusing outpatient procedures. This unlimited personalized attention can dramatically decrease hospital readmissions, according to Bickmore.

In fact, a majority of patients involved in clinical trials—particularly those with limited health and computer literacy—reported feeling more at ease interacting with avatars like Tanya than with live nurses.

Bickmore and Abby King of the Stanford University School of Medicine recently received a $3 million grant from the National Institutes of Health to compare the effectiveness of avatars to human coaches in convincing older Americans to exercise more. In 2011, Bickmore won a five-year, $3.5 million grant from the National Cancer Institute to develop avatars that guide patients through complex clinical trials.

Ultimately, he says, all of his research is focused on helping patients take care of themselves.